Tumbarello R, Cardu G, Bande A, Bini R M, Abbruzzese P A, Martelli V, Sanna A
Servizio di Emodinamica, Ospedale San Michele, Cagliari.
G Ital Cardiol. 1994 May;24(5):491-502.
To verify changes of pulmonary venous flow pattern before and after surgical or percutaneous correction of valvular heart disease.
The pulmonary venous flow pattern was studied by transesophageal echocardiography in 27 patients affected with heart valve disease (11 mitral insufficiency, 10 mitral stenosis, 2 aortic stenosis and 4 pulmonary stenosis), before and after surgical or percutaneous correction. Pulmonary venous flow velocity variables measured included peak systolic and diastolic flow velocities (VmaxS and VmaxD), systolic and diastolic velocity time integrals (IS and ID) and their respective ratios (VmaxS/VmaxD and IS/ID). Paired Student's t-test was used for analysis of data; a p value < 0.05 was considered statistically significant.
In mitral stenosis and insufficiency, as well as in pulmonary stenosis, the VmaxS/VmaxD and IS/ID ratios were constantly < 1. Aortic stenosis, on the contrary, showed a normal preoperative pattern of pulmonary venous flow, which did not change after correction. All other successful corrections (17 surgeries, 4 angioplasties) were characterised by an increase of VmaxS/VmaxD and IS/ID ratios. (Mitral stenosis: VmaxS/VmaxD 0.80 +/- 0.31 vs 1.4 +/- 0.5, p = 0.006; IS/ID 0.86 +/- 0.77 vs 1.62 +/- 0.62, p = 0.016. Severe mitral insufficiency: VmaxS/VmaxD -0.71 +/- 0.32 vs 1.19 +/- 0.32, p < 0.0001; IS/ID 0.41 +/- 0.19 vs 1.04 +/- 0.31, p = 0.006. Moderate mitral insufficiency: VmaxS/Vmax D 0.38 +/- 0.04 vs 0.95 +/- 0.06, p = 0.001; IS/ID 0.32 +/- 0.05 vs 0.95 +/- 0.07, p = 0.02. Pulmonary stenosis: VmaxS/VmaxD 0.43 +/- 0.23 vs 1.09 +/- 0.35, n.s. e IS/ID 0.49 +/- 0.34 vs 0.92 +/- 0.65, n.s.). Failure to return to a normal pulmonary venous pattern was observed in the 2 cases of partially successful mitral valvuloplasty (one of which was subsequently transformed into a mitral valve replacement with immediate normalisation of the pattern) and in the 2 cases of incomplete relief of a pulmonary stenosis after pulmonary valvuloplasty.
Though preliminary, these observations suggest a high sensitivity of this method and, therefore, a possible role of pulmonary venous pattern studies in the assessment of the efficacy of treatment in mitral and pulmonary valve disease.
验证瓣膜性心脏病手术或经皮矫正前后肺静脉血流模式的变化。
采用经食管超声心动图对27例心脏瓣膜病患者（11例二尖瓣关闭不全、10例二尖瓣狭窄、2例主动脉狭窄和4例肺动脉狭窄）手术或经皮矫正前后的肺静脉血流模式进行研究。测量的肺静脉血流速度变量包括收缩期和舒张期峰值流速（VmaxS和VmaxD）、收缩期和舒张期速度时间积分（IS和ID）及其各自的比值（VmaxS/VmaxD和IS/ID）。采用配对学生t检验进行数据分析；p值<0.05被认为具有统计学意义。
在二尖瓣狭窄和关闭不全以及肺动脉狭窄中，VmaxS/VmaxD和IS/ID比值始终<1。相反，主动脉狭窄术前肺静脉血流模式正常，矫正后未发生变化。所有其他成功的矫正（17例手术、4例血管成形术）的特征是VmaxS/VmaxD和IS/ID比值增加。（二尖瓣狭窄：VmaxS/VmaxD 0.80±0.31对1.4±0.5，p = 0.006；IS/ID 0.86±0.77对1.62±0.62，p = 0.016。重度二尖瓣关闭不全：VmaxS/VmaxD -0.71±0.32对1.19±0.32，p<0.0001；IS/ID 0.41±0.19对1.04±0.31，p = 0.006。中度二尖瓣关闭不全：VmaxS/Vmax D 0.38±0.04对0.95±0.06，p = 0.001；IS/ID 0.32±0.0对0.95±0.07，p = 0.02。肺动脉狭窄：VmaxS/VmaxD 0.43±0.23对1.09±0.35，无统计学意义；IS/ID 0.49±0.34对0.92±0.65，无统计学意义。）在2例二尖瓣成形术部分成功的病例（其中1例随后转变为二尖瓣置换术，模式立即恢复正常）和2例肺动脉瓣成形术后肺动脉狭窄不完全缓解的病例中，未观察到恢复正常肺静脉模式。
尽管这些观察结果是初步的，但表明该方法具有较高的敏感性，因此肺静脉模式研究在评估二尖瓣和肺动脉瓣疾病治疗效果方面可能具有一定作用。
